KONGU ENGINEERING COLLEGE, PERUNDURAI, ERODE-638 052

(An Autonomous Institution affiliated to Anna University, Coimbatore )

Estd.1984 TWO DAY SEMINAR

ON
MODELING AND SIMULATION FOR INDUSTRIAL AUTOMATION
DECEMBER 18 - 19, 2009
REGISTRATION FORM
Name :Mr./Ms.

Qualification :

Designation :

Sex :

Department / College :

Address for Communication :

Telephone No.
:
E-mail ID :

Accommodation Required : Yes/No

Fee Details Name of Bank:
DD. No & Date

DECLARATION: The above information is true to the best of my knowledge. I agree to abide by the rules
and regulations governing the course. If selected, I shall attend the course for the full duration. I also
undertake the responsibility to inform the coordinator in advance in case I am unable to attend the course
Place :
Date :
Signature of the Applicant

SPONSORING CERTIFICATE
Mr./Ms./Prof./Dr.……………………………………………………………………………………
is an employee of our Institution/Organisation and is hereby sponsored and permitted to attend the course,
if selected.
Place :
Date :
Office seal Signature of the Sponsoring Authority